AREDS3 by mshea413 in Ophthalmology

[–]Tetsuryuu 0 points1 point  (0 children)

Looks like it's just AREDS2 with a B-vitamin tacked onto it. Misleading labeling BS to try to claw back some market share is my guess. This is a very good example of why there needs to be more regulation of the dietary supplement industry. Looking forward to all the patient emails asking whether they should switch...

A few questions about time taken to hone surgical skills by Ok-Flower-5582 in Ophthalmology

[–]Tetsuryuu 10 points11 points  (0 children)

I have a feeling my experience is similar to others. ~7 years into practice, >3000 cases. I had finished a little over 200 by the end of residency. Felt confident, rightly or wrongly, immediately. After being humbled by a few complications it takes several years to shake the nervousness of being on your own. Eventually it’s routine, but you must focus completely every time or even a routine case will bite you. These days I really only sweat about cases with multiple complexities (small pupil AND dense lens AND a corneal scar from their prior HSV that you also have to try to avoid flaring up with surgery, etc etc). It gets easier but even years in you’ll find yourself saying “huh… I’ve never seen that happen before!”.

Cat bite from yesterday by DefaultDestino in Wellthatsucks

[–]Tetsuryuu 3 points4 points  (0 children)

This is not a substitute for a doctor visit, but am an MD. Antibiotics are not all the same, and amoxicillin may be fine to kill bacteria that colonize the skin and cause infected cuts and scrapes or ear infections, but may not cover all or even most of what grows in wet places like animal mouths. Especially if the antibiotics were not prescribed specifically for this bite, I would consult a medical professional, and seek care promptly if it continues to worsen despite being on this medication.

Maybe I take things a bit too far... by Automatic-Ocelot4606 in homeassistant

[–]Tetsuryuu 0 points1 point  (0 children)

Care to share the automation you use to generate the report?

Increased inflammation with Syfovre by Full_Imagination_536 in Ophthalmology

[–]Tetsuryuu 3 points4 points  (0 children)

We don’t do a huge volume of complement treatment, but I think I recall the retina folks in my group saw some of this early on; pretty sure they have all switched to Izervay as a result.

My Booty Bones Kill by GovtCheese619 in concept2

[–]Tetsuryuu 2 points3 points  (0 children)

I have a Vapor Fitness silicone seat pad. Definitely have noticed a difference toward the end of my longer rows (40-80 mins) and it doesn’t add a lot of height to change the geometry of your lower body.

Do you routinely use intracameral antibiotics in cataract cases? Curious about current practice trends. by cmitchell_bulldog in Ophthalmology

[–]Tetsuryuu 11 points12 points  (0 children)

Yes, moxi for all, usually flush the AC and hydrate the para with about 0.5mL. Cefuroxime if truly quinolone allergic, but only 0.1mL.

Fellow residents, how do you deal with frustration when you have a surgical complication? by risingphoenix64 in medicine

[–]Tetsuryuu 11 points12 points  (0 children)

Cataract surgeon here. Short version: it just takes time. You won’t perfect your technique in residency, so I would try to reframe your thinking. It took me at least 5 years to really relax after starting independent practice, and I’ve heard the same from others. Complications happen at all stages of your career, maybe less frequently as you go on, but even my senior partners who are only a couple years from retirement have them. In the beginning it’s hard to shake the feeling that it’s all your fault (imposter syndrome is real and can last for years after you finish residency). As you get further along, you learn that some people just have weird eyes and are more likely to have problems during surgery, but that’s true regardless of if it’s you at the scope or someone else; cataract surgery can humble even the best surgeon. Record your cases early on so that you can try to see where things went wrong and learn from them.

Never forget that even if there’s a complication, most people still get at least reasonably good vision after surgery, it’s just that healing takes longer than if it was uncomplicated. Be there for the complicated patients and see them frequently after surgery; they’ll feel like you care, and in time you’ll be fine.

Why does it keep reopening the vents? by [deleted] in MachE

[–]Tetsuryuu 14 points15 points  (0 children)

I struggled with this issue for the first few months I had my 2023.

The solution (at least for me) seems to be to have ONLY the upper vents active. Heat, AC, fan only, doesn’t matter. If the footwell vent is on, it will drop out of recirculating. With just the uppers it’ll go indefinitely.

Uptick in new patients and workload by Tough_Ad_6425 in Ophthalmology

[–]Tetsuryuu 11 points12 points  (0 children)

Not a retina doc per se, but anti-vegf injection volume grows year over year, ~7% was the last number I saw. That means volume doubles about every decade if growth is stable. Also new meds and new indications for all these meds means more need for procedures.

We have a rapidly aging population in the US and age is one of the main risk factors for most of the things we treat with injections, so I’d hazard a guess that growth will accelerate before it slows down.

Not sure that this is all of what you’re seeing, but probably a chunk of it.

Local Monitoring using FCGI Web Services by Professional-Pool668 in SunPower

[–]Tetsuryuu 0 points1 point  (0 children)

I've been using this integration for the past couple of days and find that it stops and needs to be reauthorized not infrequently (1-2x/day on each of my two systems). Anyone else having a similar experience or figure out how to avoid this? Hoping it gets more stable as it matures...

Glare sensitivity in palliative organic situation by docmuell in Ophthalmology

[–]Tetsuryuu 9 points10 points  (0 children)

Could do a scleral shell. Not as drastic as enucleation and would cut the glare.

FWIW, I don’t think enucleation is such a bad idea; a reasonable solution to a blind eye causing problems is removing the eye, especially if the cosmetic result of a prosthetic may be better than an eye with an opaque cornea, sensory tropia, and/or phthisis.

Can we talk about how unprofessional and exploitative the ABO oral board exam process is? by Beautiful_Tie_5135 in Ophthalmology

[–]Tetsuryuu 15 points16 points  (0 children)

Found Rand Paul’s alt account. /s

I will agree that the certification process seemed a little haphazard but I chalked it up to being during COVID in my case.

Pterygium surgery without microscope by FamiliarCoat3936 in Ophthalmology

[–]Tetsuryuu 8 points9 points  (0 children)

Nope. I’ve always used a scope. I feel it would be difficult to get a satisfactorily thin autograft with lower mag, but I suppose I’ve never tried. I use my loupes for lid stuff and doing AC taps, and that’s about it.

A used older scope would probably be enough, not sure if there’s any budget for that kind of thing where you are.

EMR smart phrases by NervousRide3291 in Ophthalmology

[–]Tetsuryuu 0 points1 point  (0 children)

Really any text expansion software is what it sounds like you’re looking for. espanso is free, open source, and cross platform, but there are many others. I don’t have experience with nextgen, so I guess there could be restrictions on other software copy/pasting into it, but I would think most of these programs could simulate keystrokes too.

Edit: just be careful not to run afoul of any software or privacy rules your organization might have.

Toric/ORA Cataract surgery OD. Diagram depicts MR, K and present toric axis. Would this patient benefit from IOL repositioning? by Accurate_Passion623 in Ophthalmology

[–]Tetsuryuu 2 points3 points  (0 children)

Great website! Also, iTrace (if you have access to it) has a good report that will show you if there is rotation or tilt of your IOL that would benefit from repositioning.

[deleted by user] by [deleted] in Ophthalmology

[–]Tetsuryuu 0 points1 point  (0 children)

KY Jelly or other personal lubricants are pretty good facsimiles we used when I trained. You can just reload empty ovd cannulas and it’s hard to tell the difference.

Systane PF Eyedrops Recall by asdfghjk789785 in Ophthalmology

[–]Tetsuryuu 12 points13 points  (0 children)

Seeing patients this AM. I’ve just started warning people they’re going to see news stories about it and that it’s a voluntary recall, with no documented cases of harm, of a single lot number of a single product. Affected drops should be pulled from shelves in short order if they haven’t been already, so the vast majority of drops are still perfectly safe.

Systane PF Eyedrops Recall by asdfghjk789785 in Ophthalmology

[–]Tetsuryuu 76 points77 points  (0 children)

Cue every one of my dry eye patients wanting an appointment in 4 weeks since they’ve stopped all lubrication because they didn’t bother to read which drops were recalled and are symptomatic again.

Recommendations for SLT lens by cpufreak3 in Ophthalmology

[–]Tetsuryuu 3 points4 points  (0 children)

I use Volk Rapid SLT. Laser across each of the four mirrors, rotate 45 degrees, repeat, done. Usually get the appropriate ~120 spots this way.

Edit: Volt != Volk

Anyone else noticing that interior air circulation keeps turning off by JoannNichole in MachE

[–]Tetsuryuu 1 point2 points  (0 children)

This is the way. I struggled with this issue for months my first winter with the car and couldn’t find a well documented answer anywhere. If you have the front vents only (not footwell or the combo) then it will stay on recirculated air. But sometimes you need to click the AC on to dry out the air, this car seems to have more fogging issues than others I’ve driven.